title: The optimal injection technique for the osteoarthritic ankle: a randomized, cross-over trial.
abstract: BACKGROUND
  To optimize the injection technique for the osteoarthritic ankle in order to enhance the effect of intra-articular injections and minimize adverse events.
  
  
  METHODS
  Randomized cross-over trial. Comparing two injection techniques in patients with symptomatic ankle osteoarthritis. Patients received an injection with hyaluronic acid using either one of the techniques. Four weeks later the second injection was given using the other technique. Primary outcome was the failure rate of the injection.
  
  
  RESULTS
  Seventy patients fulfilled the study. The failure rate for both injection techniques was 24%. Forty-one patients in the traction group and thirty-nine in the group without traction experienced treatment related local adverse events. Other secondary outcomes did not show any difference between injection techniques.
  
  
  CONCLUSIONS
  There is no significant difference comparing the two injection methods regarding any of our formulated outcome measures. The use of contrast aided fluoroscopy for injecting the severe osteoarthritic ankle can be advised at all times.
authors.affiliation: Department of Orthopedics, Sint Maartenskliniek, Hengstdal 3, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: a.witteveen@maartenskliniek.nl.
authors.forename: Angelique G H
authors.initials: AG
authors.lastname: Witteveen
authors.forename: Aimee
authors.initials: A
authors.lastname: Kok
authors.forename: Inger N
authors.initials: IN
authors.lastname: Sierevelt
authors.forename: Gino M M J
authors.initials: GM
authors.lastname: Kerkhoffs
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint; D018592:Cross-Over Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007270:Injections, Intra-Articular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D057240:Patient Preference; D014143:Traction; D055675:Viscosupplements / Q000627:therapeutic use; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Ankle; Hyaluronic acid; Injection technique; Osteoarthrits